Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery

Abstract

OBJECTIVE Frailty’s role in preoperative risk assessment in spine surgery has increased in association with the increasing size of the aging population. However, previous frailty assessment tools have significant limitations. The aim of this study was to compare the predictive ability of the Risk Analysis Index (RAI) with the 5-factor modified frailty index (mFI-5) for postoperative spine surgery morbidity and mortality. METHODS Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for adults > 18 years who underwent spine surgery between 2015 and 2019. Multivariate modeling and receiver operating characteristic curve analysis, including area under the curve/C-statistic calculations, were performed to evaluate the comparative discriminative ability of RAI and mFI-5 on postoperative outcomes. RESULTS In a cohort of 292,225 spine surgery patients, multivariate modeling showed that increasing RAI scores, and not increasing mFI-5 scores, were independent predictors of increased postoperative mortality for the trauma, tumor, and infection subcohorts. In the overall spine cohort, both increasing RAI and increasing mFI-5 scores were associated with increased mortality, but C-statistics indicated that the RAI (C-statistic 0.802 [95% CI 0.800–0.803], p < 0.0001, DeLong test) had superior discrimination compared with the mFI-5 (C-statistic 0.677 [95% CI 0.675–0.679], p < 0.0001, DeLong test). In subgroup analyses, the RAI had superior discriminative ability to mFI-5 for mortality in the trauma and infection groups (p < 0.001 and p = 0.039, respectively). CONCLUSIONS The RAI demonstrates superior discrimination to the mFI-5 for predicting postoperative mortality and morbidity after spine surgery and the RAI maintains conceptual fidelity to the frailty phenotype. Patients with high RAI scores may benefit from knowing the possibility of increased surgical risk with potential spine surgery.

The Fine Line Between Simplicity and Oversimplification: Comparing the Risk Analysis Index and 5-Factor Modified Frailty Index as Frailty Assessment Tools

“…Despite this the mFI-11, an extended, comorbidity-based frailty measure version of the mFI-5, is the most commonly reported frailty index, garnering considerable attention in the neurosurgery spine literature [ 6 ]. RAI is an alternative screening tool that evaluates a patient’s overall health status based on various factors, including age, functional dependence, and comorbidities.5,7 RAI offers several advantages, such as its ease of use and integration into clinical workflows [ 7 - 10 ]. Studies in the neurosurgery literature, encompassing a wide range of routinely performed procedures, such as spinal [ 7 ], cranial [ 10 ], and functional [ 8 , 9 ] surgeries, demonstrate that the RAI consistently exhibits superior discrimination compared to mFI-5, and greater patient age [ 7 - 10 ].…”

“…RAI is an alternative screening tool that evaluates a patient’s overall health status based on various factors, including age, functional dependence, and comorbidities.5,7 RAI offers several advantages, such as its ease of use and integration into clinical workflows [ 7 - 10 ]. Studies in the neurosurgery literature, encompassing a wide range of routinely performed procedures, such as spinal [ 7 ], cranial [ 10 ], and functional [ 8 , 9 ] surgeries, demonstrate that the RAI consistently exhibits superior discrimination compared to mFI-5, and greater patient age [ 7 - 10 ]. Moreover, in these studies the RAI has been shown to be more effective in predicting a wide variety of adverse outcomes [ 7 - 10 ].…”

“…Studies in the neurosurgery literature, encompassing a wide range of routinely performed procedures, such as spinal [ 7 ], cranial [ 10 ], and functional [ 8 , 9 ] surgeries, demonstrate that the RAI consistently exhibits superior discrimination compared to mFI-5, and greater patient age [ 7 - 10 ]. Moreover, in these studies the RAI has been shown to be more effective in predicting a wide variety of adverse outcomes [ 7 - 10 ].…”

Substantial Loss of Skeletal Muscle Mass Occurs After Femoral Fragility Fracture

“…Comorbidities also impact nutritional status and loss of skeletal muscle mass. For this study, we classified comorbidity using the Modified Frailty Index 31,40-42 . Sarcopenia and loss of skeletal muscle mass were not associated with frailty in this study.…”

Commentary: The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review

“…6,[11][12][13][14] It underscores the importance of using frailty assessment tools that are appropriate for the context and have been rigorously validated, such as the Risk Analysis Index, which has shown strong discriminatory accuracy in predicting surgical outcomes across various age groups. [15][16][17] The authors also present a brief comparison of frailty scores based on the 10 core principles defined in Table 4 that offers comparison for these tools. 6 However, a more comprehensive exposition is warranted, and a balanced comparison of the limitations inherent in both Risk Analysis Index and HFRS and other alternate risk scores should be undertaken to attain consensus within the field for a tool with most accurate predictability and better utilization across practice settings for risk-stratification and intervention decisions of our patients.…”